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Ambulance crews in the District have been making a hospital in Cheverly one of their regular stops since the city government closed D.C. General Hospital in 2001.

According to city records obtained by The Washington Times, D.C. ambulances deliver patients to Prince George’s Hospital Center nearly four times more often than they did before D.C. General closed.

The movement of patients across the Maryland-D.C. border figures large in a dispute between state and city officials over whether the District should pay for its poor residents who get free care in Prince George’s County.

The Times first reported last week that the nonprofit company that owns Prince George’s Hospital Center recently billed the District for the treatment of thousands of poor D.C. residents in the past three years.

Dimensions Healthcare Systems says the D.C. government owes it more than $5 million for care that its facilities have provided for poor city residents, mostly at Prince George’s Hospital but also at Laurel Regional Hospital and Bowie Health Center, which the company also owns.

The company has the backing of Maryland’s top public-health official, Maryland Secretary of Health and Mental Hygiene Nelson J. Sabatini.

“The standing joke is that ambulance drivers in the District check, and if you have health insurance, you go to D.C.; and if not, then they go to the Maryland line,” Mr. Sabatini said Friday. “I am totally supportive of what Prince George’s Hospital is doing.”

City officials, who are refusing to pay the bill, say that many uninsured Maryland residents also come to the District for treatment and that government officials can’t control where patients seek care.

The District denied the payment claim in a July 14 letter to Dimensions from D.C. Associate Chief Financial Officer Deloras Shepherd, who said the city doesn’t have a contractual relationship with hospitals outside the District.

City ambulance crews have taken more than 400 trips to drop off patients at Prince George’s Hospital each year since D.C. General was closed in 2001, compared with 112 trips in 2000, according to statistics.

The figures do not distinguish between paying and nonpaying patients, D.C. emergency medical services spokesman Alan Etter said. Nor is everybody taken by D.C. ambulance to Prince George’s Hospital necessarily a D.C. resident, he added.

“When we transport to Prince George’s, it is for a serious, traumatic injury in that part of the city,” he said.

In 2001, when D.C. General closed in June, the number of city ambulance transports to Prince George’s Hospital hit 406. City crews took 425 trips in 2002 and 418 trips last year, statistics show. There have been 179 trips so far this year through June 30.

Prince George’s officials say the trend shows that the District has grown increasingly reliant on the Cheverly-based hospital just outside of Northeast D.C.

“Certainly, as Dimensions has demonstrated, Prince George’s Hospital’s uncompensated care [patient] load has been increased by reason of the closing of D.C. General,” said County Council member Thomas Hendershot. “It’s appropriate for them to ask for compensation from D.C. government.”

D.C. officials counter that they had the same problem when D.C. General was open, saying many indigent Maryland residents received free hospital care from the District at the city’s Ward 6 hospital.

A spokesman for Mayor Anthony A. Williams said the District is unlikely to write a check to Dimensions, although Mr. Williams would like to start discussing the problem with Prince George’s officials.

“The mayor’s position is that he would like to start a dialogue with Prince George’s County officials on this question,” said Tony Bullock, a spokesman for Mr. Williams.

Dimensions senior vice president K. Singh Taneja first sought the city funds by billing the D.C. Healthcare Alliance in June. The alliance is the city’s $96 million insurance plan that began in 2001 to fill the gap in services created by the closing of D.C. General. Providers in the plan include city hospitals, clinics and private physicians.

Mr. Taneja, who as former chief operating officer of Greater Southeast Hospital in D.C. helped create the D.C. Healthcare Alliance, declined to comment for this story yesterday.

D.C. hospital industry officials argue that Maryland residents who can’t pay their bills also come to the District, although they say no citywide statistics were readily available.

“We know we get patients who live in Maryland who have no ability to pay,” said Robert Malson, president of the D.C. Hospital Association.

Maryland residents accounted for 36.6 percent of overall inpatient admissions at D.C. hospitals in 2002, sending more than $800 million to the city’s hospitals, according to an analysis of the hospital association’s annual financial report.

“I don’t think either jurisdiction will benefit by a war that could erupt over this,” Mr. Malson said.